Provider Demographics
NPI:1528223583
Name:SERGIO G. PRECIADO, M.D., P.A.
Entity Type:Organization
Organization Name:SERGIO G. PRECIADO, M.D., P.A.
Other - Org Name:MISSION CHILDREN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRECIADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-787-2500
Mailing Address - Street 1:832 DEL ORO AVE.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2200
Mailing Address - Country:US
Mailing Address - Phone:956-787-2500
Mailing Address - Fax:956-787-2524
Practice Address - Street 1:1616 N. CONWAY AVE.
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4004
Practice Address - Country:US
Practice Address - Phone:956-580-9966
Practice Address - Fax:956-580-1964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERGIO G. PRECIADO, M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty